What hospitals want from Donald Trump and the new Congress

The new Congress has been seated and today, Donald Trump will be sworn in and begin his second term as president.

Hospitals and health systems are pushing President Donald Trump and the new Congress to preserve funding and address some key priorities this year, including Medicare, Medicaid, telehealth, and more.

Hospitals will be pressing lawmakers and the new administration to support health systems and providers, and they have a number of big priorities. Some are issues that weren’t addressed in the short-term funding package lawmakers approved for the holidays, or left out of the package altogether.

And some involve issues that weren’t resolved in the last session of Congress, and perhaps for years.

Lisa Kidder Hrobsky serves as senior vice president of federal relations, advocacy and political affairs for the American Hospital Association. She tells Chief Healthcare Executive® that hospital and healthcare leaders are anxious to see how they will fare with new leaders in Washington.

“I think that anytime that you have a new administration coming in, you are concerned or worried about what some of the new policies might be,” Kidder Hrobsky says.

“It certainly puts us on notice that we need to make certain that we're front and center this year, talking about hospitals and health systems, their financial situations, and the value to their patients,” she says.

• Read more: How Donald Trump's return affects hospitals: Medicaid, the Affordable Care Act, and tariffs

Trump has talked about finding ways to cut spending and waste in the federal government. He tapped Elon Musk and Vivek Ramaswamy to lead the Department of Government Efficiency, or DOGE, to identify areas to reduce spending.

Plus, Republicans, who now control both the House and Senate, may attempt to utilize the process of reconciliation to deal with the budget. In the budget reconciliation process, Congress could pass spending bills with a majority vote instead of a veto-proof majority in the Senate, but the process is complicated.

With that background, here’s a look at what hospitals are seeking from Washington.

Medicare funding

Hospitals and health systems rely on Medicare funding as a lifeline. Hospitals have said Medicare reimbursements fall short of covering the cost of care hospitals provide. Certainly, hospitals are hoping to do better, but they’re also hoping to make sure there aren’t reductions that would pose even bigger financial challenges.

Hospitals are also concerned about growing support for “site neutral” funding policies for outpatient services.

Some lawmakers are aiming to change Medicare payment policy so that Medicare would pay the same rate for outpatient services, whether the services are delivered in a hospital, or an ambulatory surgery center or some other outpatient clinic. Supporters say such a change would save Medicare billions of dollars, and lead to lower costs for consumers.

Hospitals have countered that they face different regulatory demands and take patients of all incomes, unlike some outpatient providers.

“We are very aware that this issue has gained prominence, both on the Republican and the Democrat side, and we are again gearing up, working with our state hospital associations, getting ready to tell the hospital story, specific to this issue, and then obviously telling the hospital story generally,” Kidder Hrobsky says.

“Any reversal of funds or reduction of funds, obviously, is going to impact healthcare,” she says.

Medicaid

Some analysts are worried about the prospect of cuts in Medicaid, the federal-state healthcare program for Americans with low-incomes. Medicaid also offers funding to hospitals, particularly those who serve disadvantaged communities.

Nonprofit hospitals could see growing financial pressure if there are significant cuts to Medicaid, Moody’s Ratings said last week.

Needless to say, hospitals are anxious to see what happens with Medicaid and will be urging the administration and leaders to avoid steep cuts.

“Medicaid is a fairly large target for some people, and they want to take a look at it,” Kidder Hrobsky says. “So we are definitely prepared, beefing up all of our data on Medicaid, making certain that we are able to tell the best story for Medicaid and the patients and the consumers who are part of it.”

Telehealth

Hospitals and health systems are anxious to see Congress and the Trump administration extend waivers for telehealth and hospital-at-home programs. And this is an issue that’s coming to a head quickly.

Telehealth waivers were set to expire at the end of 2024, and lawmakers offered an extension in the stopgap spending bill approved in December. But the extension for telehealth programs only goes through March, falling short of the multi-year extension hospitals and healthcare providers had been seeking.

Lawmakers had initially put forth a two-year extension for telehealth programs, and a five-year extension for hospital-at-home programs, but they settled for a short-term extension along with other government programs in March.

Kidder Hrobsky says she still sees strong support for telehealth and hospital-at-home programs.

“People are continuing to look at them and evaluate them, but I certainly think there's bipartisan support for continuing both of those programs,” she says. “Obviously, come the end of March, we'll be looking to make certain that any funding package would include additional extensions.”

Trump signed off on waivers easing restrictions on telehealth programs early in the COVID-19 pandemic.

Rural hospitals

Small, rural hospitals have been struggling for years, and hospitals have been pushing to preserve Medicare programs that offer critical aid for those facilities. The stopgap funding package extended funding lines that were set to expire at the end of the year: The Medicare-Dependent Hospital (MDH) program and Medicare’s Low-Volume Hospital (LVH) program.

Hospitals will be looking to preserve those programs, and Kidder Hrobsky is optimistic about their future.

“I definitely think the programs will continue,” she says. “They have been in existence and extended for many, many years now. My guess is that these programs probably wouldn't stop being extended.”

Kidder Hrobsky says Congress may look more comprehensively at rural health. “We know there's been some interest in looking at that,” she says.

The 340B program

Hospitals are pushing to preserve the federal 340B drug pricing program, which enables health systems serving disadvantaged communities to purchase some outpatient drugs at lower costs.

The program has been the center of intense battles between drug companies, who have pushed to reduce the scope of the program, and hospitals seeking to maintain it.

Lawmakers have given more scrutiny to the program over the past few years, with Republicans last year seeking to impose new eligibility requirements for hospitals.

Some drug companies have also been reducing their discounts, angering hospitals and health providers and leading to more legal battles.

Prior authorization

Hospitals and physicians have been pushing for Congress to rein in insurance companies when it comes to prior authorization, the process of securing approval from insurers for treatment of procedures.

Hospitals say they are seeing more delays and denials from insurance companies, which is delaying patient care and adding to their costs. Hospitals also say they have been seeing more problems with Medicare Advantage plans and their use of prior authorization.

Republicans and Democrats, including new Senate Majority Leader John Thune, R-South Dakota, have backed legislation to streamline prior authorization in Medicare Advantage plans.

Workplace violence

Hospitals have been pushing Congress for years to approve legislation that would impose tougher penalties for those who attack hospital staff and healthcare workers.

The American Hospital Association has been pushing for changes in federal law to give hospital workers the same type of protections as those working for airlines. Some states have passed similar legislation, but hospitals have pushed for strengthening the law nationwide.

Despite bipartisan support for such measures, lawmakers haven’t been able to get a bill through Congress.

The Emergency Nurses Association surveyed its members last spring, and found more than half (56%) said they had been physically assaulted, verbally harassed or threatened with violence within the past 30 days.